This week my Mexican mentor Isa and I visited my favorite hospital in Puebla… that’s right, Christus Muguerza (Hospital UPAEP). UPAEP is the University where I’ve been taking Spanish classes (and also where I studied in January). I’ve had a general tour of CM, been a patient for 4 glorious days, and now… I’ve met with the nutrition department and kitchen staff for some in-depth nutrition research.
If you remember from my blog, CM is a private hospital, which means it’s quiet, clean, has great resources and capabilities and is never really crowded (usually 4 – 20 patients). For these reasons and because of the wonderful staff they have, CM is the first hospital I have actually ENJOYED being in. Personally, I find hospitals in general to be cold, clinical and not a wonderful place to spend your time. That’s why I’ve never really had aspirations to work in a hospital. My my my, how things are changing.
Needless to say, I had high expectations for the nutrition department. When I say department, I mean the nutritionist on staff and her intern because there isn’t anyone else. Truthfully, there isn’t a need for more than that. The hospital has no more than 20 patients at a time and usually far far less than that. When we visited there were only 3 patients who needed lunch. Our first stop was to the kitchen. I was very glad to learn that CM has a separate kitchen for patients and the cafeteria. This is comforting because in truth, to have a kitchen only for patients offers more control, eliminating any cross-contamination AND unlike Hospital Puebla, the women who prepare the meals are not outside chefs contracted by the hospital. I can also say that the cooks are among the most wonderful employees of the hospital. It’s like having you grandma cooking for you. Which makes me wonder why I distinctly remember the food NOT being appetizing. During our tour they had beans cooking, rice, soup, and some stew. Maybe it was because I was so nauseous? Or perhaps the ‘yo soy vegetariana’ caused some issues. That happens a lot.
Anyways, in the kitchen, like at H. Puebla, the nutritionist sends a list including the diagnosis, diet order and room number for each patient. The diet orders correspond to a color system, and each food tray represents the color for each prescribed diet. For example:
Red – bland
Yellow – normal
Blue – diabetic
Orange – low sodium
Purple – liquid
Green – renal
This color system eliminates the chance for errors in sending the wrong diet UNLESS it’s the doctor that prescribes the incorrect diet (like my renal dr. forgot to mention that I was vegetarian, so I was sent meat juice at some point). Also, there’s a dry-erase board with the room numbers where the nutritionist/cooks can write special indications, such as “dislikes vegetables.”
The kitchen staff is responsible for creating the daily menu, which surprisingly changes a lot. There was a lot of fresh vegetables in the kitchen, and almost everything is made from scratch. The menu for this week looked something like this:
Monday
Breakfast: Quesadillas de requeson con espinacas/ Coctel de frutas natural/ Frijoles del la olla
Lunch: Codito rojos con jamon y queso panela/ Tostadas de pollo/ Tarta de duranzon
Dinner: Tortilla Espanola/ Frijoles refritos/ Gelatina mosaico
Tuesday
Breakfast: Chilaquiles verdes/ Arroz con leche
Lunch: Sopa de fideo/ Chuletas de cerdo en crema de chipotle/ Pina en almibar
Dinner: 2 empanadas de carne/ Platanos con crema/ Chispas de chocolate
Wednesday
Breakfast: Pambazo de jamon, queso y frijoles refritos/ Papaya
Lunch: Espaqueti blanco/ Pechuga de pollo asada/ Raja poblanas con crema y elotitos/ Naranja en cuartos
Dinner: Hot dogs/ Yogurt
I didn’t translate any of the foods because although foods like “espinaca” directly translates to “spinach” in English, a dish such as “chilaquiles” has no English equivalent. Hot dogs and yogurt are pretty obvious and I’m wondering what the hell that’s about anyways… hot dogs with yogurt for dinner!? Unfortunately, we find that the doctor is responsible for prescribing a diet and the kitchen staff creates the menu – leaving little room for the nutritionist to influence what foods the patients consumer. Although, there is more collaboration at CM with the nutrition department, and a doctor will in theory refer a patient to the nutritionist when needed.
Something that I discovered about nutritionists in Mexico, is that generally at a hospital there is only 1 or 2 nutritionists on staff, they really only see patients when a doctor makes a referral, and for the most part – they have no area of expertise. They are general nutritionists responsible for servicing patients of any type of condition. I’m sure it’s not the same everywhere, and Isa did say that it’s possible to receive credentials for a specific area (for example, for renal care or diabetes). Also, it is rare to find a nutritionist with their master’s, it’s not as necessary in Mexico – a bachelors degree is sufficient to work. As it is in the US now, bachelors degree is hardly sufficient for any career, especially the health sciences.
**Personal side note, I’m debating whether I should apply for the master’s program or not at the moment. There’s a lot of reasons why I should and an equal amount for why I shouldn’t. The master’s programs in New York City are all highly competitive as well, so I need to have A LOT of experience to even have a prayer at being excepted. I can tell you though that I am so relieved I didn’t apply to being this fall. I need time to gain real working experience, and to discover which area of nutrition most interests me. I thought I had it figured out, but we never really do. It’s ridiculous that students graduate with their bachelors and go straight to the master’s program without ever having to actually work. You wind up graduating at the ripe old age of about 24 with absolutely no work experience but lots of education. Who would you prefer to be counseled by? Do NOT, I repeat, DO NOT apply to a master’s program for the following reasons:
1. Do defer your student loan payments
2. Because you don’t have any current job prospects and you generally don’t know what you want to do in the future
3. Because if you “don’t stay in school and do it now, you won’t ever go back and complete a master’s”
I won’t lie – all of these crossed my mind as excellent reasons to apply to a master’s program. Although Tripp will kill me for dissuading you from immediately starting your master’s, I stand by my belief that some amount of work experience, living in the real world will make your master’s a completely different experience when you decide to apply – one that you may just appreciate a lot more because it won’t be only “memorizing information,” but actually understanding how the information is applied. Receiving a master’s degree is necessary for our generation to secure us jobs that will pay a decent amount, but in general, I don’t respect a professional strictly based on their credentials. The truth is, there are endless career options in the field of nutrition (working for hospitals, nursing homes, schools, in the government, for a private company, for yourself… the list goes on!) With different work experience you’ll eventually find the area that suits you best. And if you discover you dislike your area, you can always try something new.
The point of my rant is that INTERNING and WORKING (usually you won’t be paid as an intern unless you’re unbelievably lucky) gives you knowledge and skills that being in a classroom can’t give you. It’s practical, applied knowledge. Classes provide you with all the information you could possibly know about a food, disease, diet, procedure, etc. but doesn’t give you the confidence that a hands-on experience will. For example, we learn that you need to be “culturally sensitive” when counseling a client. Ok. Well, the concept of “culturally sensitive” is generally meaningless until you’ve worked with clients of different backgrounds, religions, family systems with certain lifestyles and eating habits or preferred foods. All of these factors affect the food choices of a person and/or family. Of course we can never really know it ALL, but until you’ve been exposed to working with clients of different cultures, you won’t experience being culturally sensitive. It’s the experience that give you the true understanding of the word that we were taught in a classroom. Experience is the key to having more confidence in yourself and providing the best quality service as a dietitian.
Now that I’m done with my rant… I’ll leave you with some nuggets of advice that I’ve come to learn along the way.
INTERNING ADVICE
- To elaborate on my previous advice – there is a HUGE difference between private and public hospitals. For the best experience, try interning at either a large private hospital or a public hospital.
- Don’t freak out if you don’t know for sure what you want to do – as long as you appreciate the opportunities that come your way.
- INTERN. Yes, my intern advice is the importance of interning. Gaining real-world work experience is more valuable than any other way of learning. Learn to apply the information that’s been crammed into your brain to actual situation.
- Plan on doing a master’s program. It will be necessary if you ever want a decent paying job – BUT I advise you to start the program when you feel ready.
- Have confidence. This is the single most important advice anyone can tell you but YOU have to fully believe it. Have confidence in what you know and the decisions that you make because no one else can decide for you. It’s your life kiddo.
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